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What’s New in Musculoskeletal Basic Science
Leucht, Philipp MD1; Einhorn, Thomas A. MD
doi : 10.2106/JBJS.21.01065
December 1, 2021 - Volume 103 - Issue 23 - p 2157-2160
Discectomy Compared with Standardized Nonoperative Care for Chronic Sciatica Due to a Lumbar Disc Herniation
Bailey, Christopher S. MD, FRCSC1,2,3; Glennie, Andrew MD, FRCSC1,2; Rasoulinejad, Parham MD, FRCSC1,2,3; Kanawati, Andrew MD, FRCSC1,2; Taylor, David MD, FRCSC1; Sequeira, Keith MD, FRCSC4; Miller, Thomas MD, FRCSC2,3,5; Watson, Jim MD, FRCSC6; Rosedale, Richard PT7; Bailey, Stewart I. MD, FRCSC1,2,3; Gurr, Kevin R. MD, FRCSC1,2,3; Siddiqi, Fawaz MD, FRCSC1,2,3; Urquhart, Jennifer C. PhD1,3
doi : 10.2106/JBJS.21.00448
December 1, 2021 - Volume 103 - Issue 23 - p 2161-2169
Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known. The purpose of the present study was to report the 2-year outcomes following lumbar microdiscectomy as compared with standardized nonoperative care for the treatment of chronic sciatica resulting from a lumbar disc herniation.
Unicompartmental Knee Arthroplasty: Survivorship and Risk Factors for Revision
Ekhtiari, Seper MD1; Bozzo, Anthony MD, MSc1; Madden, Kim PhD1,2; Winemaker, Mitchell J. MD, FRCSC1,3; Adili, Anthony MD, PEng, FRCSC1,2; Wood, Thomas J. MD, FRCSC1,3,a
doi : 10.2106/JBJS.21.00346
December 1, 2021 - Volume 103 - Issue 23 - p 2170-2176
Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database.
Increased Early Mortality in Bilateral Simultaneous TKA Using Conventional Instrumentation Compared with Technology-Assisted Surgery
Kirwan, David P. MBBS, FRACS1; B(IMIS), Yi Peng, MMed(Epi&Stats)2; Harris, Ian A. MBBS, MMed(ClinEpi), PhD, FRACS3,4,a
doi : 10.2106/JBJS.21.00029
December 1, 2021 - Volume 103 - Issue 23 - p 2177-2180
Controversy exists regarding the safety of bilateral simultaneous total knee arthroplasty (BSTKA). When conventional instrumentation is used, the increased fat emboli that result from the insertion of intramedullary rods may increase the risk of perioperative complications. We hypothesized that the use of technology-assisted instrumentation (avoiding intramedullary involvement) would be associated with a lower rate of early postoperative death compared with the use of conventional instrumentation.
Are Patient Linguistic Tones Associated with Mental Health and Perceived Clinician Empathy?
Al Salman, Aresh MD1,2; Kim, Ashley BSc1; Mercado, Amelia1; Ring, David MD, PhD1,a; Doornberg, Job MD, PhD2; Fatehi, Amirreza MD1; Crijns, Tom J. MD1
doi : 10.2106/JBJS.21.00124
December 1, 2021 - Volume 103 - Issue 23 - p 2181-2189
Musculoskeletal specialists have the expertise to distinguish between (1) symptoms that correspond well with observed pathophysiology and (2) disproportionate or incongruent symptoms that may suggest mental and social health opportunities. There is evidence that patient verbal and nonverbal communication can help with this discernment. This study carried this line of research one step further by addressing whether patient linguistic tones, as assessed with use of Linguistic Inquiry and Word Count (LIWC), are associated with symptoms of depression and health anxiety. We also sought associations between both patient and clinician linguistic tones and patient-perceived clinician empathy.
Optimizing Costs and Outcomes for Carpal Tunnel Release Surgery
Rogers, Miranda J. MD, MS1; Stephens, Andrew R. MD1; Yoo, Minkyoung PhD2; Nelson, Richard E. PhD3,4; Kazmers, Nikolas H. MD, MSE1,a
doi : 10.2106/JBJS.20.02126
December 1, 2021 - Volume 103 - Issue 23 - p 2190-2199
It is unclear which carpal tunnel release (CTR) strategy (i.e., which combination of surgical technique and setting) is most cost-effective. A cost-effectiveness analysis was performed to compare (1) open CTR in the procedure room (OCTR/PR), (2) OCTR in the operating room (OCTR/OR), and (3) endoscopic CTR in the operating room (ECTR/OR).
Pregabalin and Persistent Postoperative Pain Following Posterior Spinal Fusion in Children and Adolescents
Helenius, Linda MD, PhD1,a; Yrjälä, Tommi MD1; Oksanen, Hanna RN2,3; Pajulo, Olli MD, PhD2; Löyttyniemi, Eliisa MSc4; Taittonen, Markku MD, PhD1; Helenius, Ilkka MD, PhD3
doi : 10.2106/JBJS.21.00153
December 1, 2021 - Volume 103 - Issue 23 - p 2200-2206
Surgical correction of spinal deformity requires major surgical intervention with extensive manipulation of the spine and neural elements. Persistent postoperative pain affects patient quality of life and can also cause financial burden for patient families and for society. We aimed to investigate the effect of perioperative pregabalin on the incidence of persistent pain following instrumented spinal fusion.
Prediction of Radial Head Subluxation and Dislocation in Patients with Multiple Hereditary Exostoses
Feldman, David S. MD1,2; Rand, Troy J. PhD1; Deszczynski, Jaroslaw MD3; Albrewczynski, Tomasz MD2; Paley, Dror MD1,2; Huser, Aaron J. DO1,a
doi : 10.2106/JBJS.20.02205
December 1, 2021 - Volume 103 - Issue 23 - p 2207-2214
Multiple hereditary exostoses (MHE) is a rare bone disease that results in growth of benign cartilage-capped tumors and a number of skeletal deformities. Forearm deformities are present in up to 60% of patients with MHE, and radial head subluxation or dislocation occurs in 20% to 30%. Radial head subluxation/dislocation results in a shortened forearm and loss of motion. The purpose of this study was to identify radiographic variables that are most predictive of radial head subluxation/dislocation in an effort to determine the need for prophylactic treatment.
Comparing Primary Total Hip Arthroplasty in Renal Transplant Recipients to Patients on Dialysis for End-Stage Renal Disease
Douglas, Scott J. MD1; Pervaiz, Sahir S. MD, MS1; Sax, Oliver C. DO, MS1; Mohamed, Nequesha S. MD2; Delanois, Ronald E. MD1,a; Johnson, Aaron J. MD3
doi : 10.2106/JBJS.20.01983
December 1, 2021 - Volume 103 - Issue 23 - p 2215-2220
Renal transplants are the most commonly performed solid-organ transplants worldwide. It is unclear whether a kidney transplant is associated with reduced postoperative complications in comparison with patients on dialysis for end-stage renal disease (ESRD). The purpose of this study was to utilize a national database to compare readmissions, complications, and costs associated with primary total hip arthroplasty (THA) between matched renal transplant recipients (RTRs) and patients on dialysis for ESRD.
The Cost-Effectiveness of Surgical Intervention for Spinal Metastases
Schoenfeld, Andrew J. MD, MSc1,a; Bensen, Gordon P. BA2; Blucher, Justin A. MS3; Ferrone, Marco L. MD1; Balboni, Tracy A. MD, MPH4; Schwab, Joseph H. MD, MS5; Harris, Mitchel B. MD5; Katz, Jeffrey N. MD, MSc1; Losina, Elena PhD1
doi : 10.2106/JBJS.21.00023
December 1, 2021 - Volume 103 - Issue 23 - p 2221-2228
Operative and nonoperative treatments for spinal metastases are expensive interventions with a high rate of complications. We sought to determine the cost-effectiveness of a surgical procedure compared with nonoperative management as treatment for spinal metastases.
Utilizing Lean Methodology and Time-Driven Activity-Based Costing Together
Sethi, Rajiv K. MD1,2,3,a; Pumpian, Rebecca P. MBA1; Drolet, Caroline E. PhD1; Louie, Philip K. MD1
doi : 10.2106/JBJS.21.00129
December 1, 2021 - Volume 103 - Issue 23 - p 2229-2236
Time-driven activity-based costing (TDABC) has been suggested as the cost-accounting arm of value-based care organizations seeking to address costing challenges from the bottom up by studying the actual processes used in patient care. Lean methodology is a system in which the care pathway is understood at a granular level. In the current study, we attempt to combine these 2 methodologies, providing a robust mechanism to detect meaningful variation. First, we used data from a single surgeon and examined differences in time and cost for patients released on postoperative days 1 or 2. Next, we compared the data from patients discharged on postoperative day 1 with those of patients who underwent an operation by a different surgeon and were also discharged on postoperative day 1.
Anatomy, Mechanics, and Surgical Management
Howatt, Jonathan MD1; Liew, Allan S. MD, FRCSC1; Wilkin, Geoffrey MD, FRCSC1,a
doi : 10.2106/JBJS.20.01478
December 1, 2021 - Volume 103 - Issue 23 - p 2237-2246
A preoperative computed tomography scan may be considered to improve surgical planning, as secondary fracture lines are poorly visualized on radiographs.
What’s Important: Using Our Role as Physicians to Combat the Climate Emergency
Mann, Jeffrey A. MD1,a
doi : 10.2106/JBJS.21.01098
December 1, 2021 - Volume 103 - Issue 23 - p 2247-2248
Pediatric Orthopaedic Observerships in North America for International Surgeons
Carrillo, Laura A. BA1; Sabharwal, Sanjeev MD, MPH2,3,a
doi : 10.2106/JBJS.21.00180
December 1, 2021 - Volume 103 - Issue 23 - p e94
Despite recommendations for high-income countries to partner with low-income and middle-income countries to expand surgical access, little is known about the barriers that are faced by international surgeons (ISs) who participate in short-term clinical observerships in North America and the barriers that are encountered by their North American (NA) hosts.
Treatment for Chronic Sciatica: Do We Have New Evidence Showing That Discectomy Has Any Long-Term Benefits Over Conservative Care?
McIff, Terence E. PhD, MBA1,a
doi : 10.2106/JBJS.21.01071
December 1, 2021 - Volume 103 - Issue 23 - p e95
Convincing Evidence to Rethink Indications for Unicompartmental Knee Arthroplasty
Balkissoon, Rishi MD, MPH1,a
doi : 10.2106/JBJS.21.00981
December 1, 2021 - Volume 103 - Issue 23 - p e96
